00 SENATE BILL NO. 138 01 "An Act relating to the state's tuberculosis control program, including provisions 02 for certain penalties; and providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. FINDINGS. The legislature finds that tuberculosis is a disease that can be 05 easily spread, is sometimes fatal, and constitutes a serious threat to the public health and 06 welfare. The state medical officers of the Department of Health and Social Services, division 07 of public health, must use every available means to ascertain the existence of, and immediately 08 investigate all reported or suspected cases of tuberculosis in the state, and to ascertain the 09 sources of that disease. The legislature further finds that in order to protect the public health 10 from the few persons with tuberculosis who pose a threat to the public, it is necessary to 11 establish a system of mandatory contact identification, treatment, hospitalization, and isolation 12 for infectious cases and a system of voluntary care and monitoring in all other tuberculosis 13 cases. 14 * Sec. 2. AS 18.15.120 is amended to read: 01  Sec. 18.15.120. TUBERCULOSIS CONTROL PROGRAM AUTHORIZED. 02 The department may establish a comprehensive program for the control of tuberculosis 03 in the state, and may 04  (1) arrange means by which persons in the state may be X-rayed to 05 determine the presence of tuberculosis; 06  (2) establish necessary out-patient clinics for the care of tuberculosis; 07  (3) encourage and promote the establishment of adequate health care 08 [SANATORIUM] facilities within the state to care for persons suffering from 09 tuberculosis and allied conditions; 10  (4) under the provisions of AS 36.30 (State Procurement Code), obtain, 11 by purchase or donation from surplus federal property or otherwise, medical supplies 12 and equipment useful in carrying out this program and to allot or resell these supplies 13 and equipment to private institutions engaged by the department to carry out this 14 program; 15  (5) under the provisions of AS 36.30, contract with hospitals, 16 associations, or other health care facilities [SANATORIUM] qualified and equipped 17 to give adequate care inside or outside the state; 18  (6) employ necessary and trained personnel to carry out the purposes 19 of AS 18.15.120 - 18.15.149 [AS 18.15.120 - 18.15.140]; 20  (7) pay the costs of care and incidental expenses for residents of the 21 state, in whole or in part, depending on the ability of each patient to pay, and the 22 temporary costs of care and transportation for nonresidents on the same basis until they 23 can be transferred to their residence; 24  (8) enlist the cooperation of state, [AND] federal, and local agencies 25 operating in the state for the furtherance of this program; 26  (9) establish standards in accordance with department procedure for the 27 care of persons with tuberculosis [TUBERCULARS] receiving treatment under 28 AS 18.15.120 - 18.15.149 [AS 18.15.120 - 18.15.140]; 29  (10) adopt regulations to implement and interpret AS 18.15.120 - 30 18.15.149. 31 * Sec. 3. AS 18.15.130 is amended to read: 01  Sec. 18.15.130. DEPARTMENT TO COOPERATE WITH OTHER 02 AGENCIES. The department, in establishing [CONDUCTING] a comprehensive 03 program for [STUDY AND CASE FINDING SURVEY OF] the control of 04 tuberculosis in the state [PROBLEM], shall cooperate with state, [AND] federal, and 05 local agencies operating in the state, and obtain as much information and data as 06 possible from them. 07 * Sec. 4. AS 18.15 is amended by adding new sections to read: 08  Sec. 18.15.131. REPORTS TO STATE MEDICAL OFFICERS; 09 DOCUMENTATION OF TREATMENT. (a) A health care provider and a laboratory 10 administrator shall report, within five working days, to a state medical officer when 11 that provider or administrator diagnoses a case of tuberculosis or has reasonable 12 grounds to believe that a patient has tuberculosis, or when a patient ceases treatment 13 for tuberculosis. A health care provider and a laboratory administrator may presume 14 that a patient has ceased treatment if the patient fails to keep an appointment or 15 relocates without transferring medical treatment to another health care provider. A 16 health care provider who treats a patient with tuberculosis, and a person in charge of 17 a health care facility that provides treatment for tuberculosis to a patient, shall maintain 18 written documentation of the patient's adherence to the patient's treatment plan. 19  (b) A person required to report under (a) of this section shall permit a state 20 medical officer to examine patient records, reports, and other data related to the 21 required report. 22  Sec. 18.15.133. EXAMINATION OF PERSONS EXPOSED TO 23 TUBERCULOSIS. (a) A health care provider who treats a patient for tuberculosis 24 shall 25  (1) examine all other persons in the household who have had contact 26 with the patient; 27  (2) refer those persons to another health care provider for examination 28 and notify the other health care provider and a state medical officer of the referral; or 29  (3) refer those persons to a state medical officer for examination and 30 promptly notify the state medical officer of the referral. 31  (b) A health care provider who examines other persons in a household under 01 (a)(1) or (2) of this section shall report to a state medical officer, within 10 days after 02 the examination, the results of the examination. 03  (c) Under AS 18.15.135, a state medical officer may order an examination of 04 a person to detect tuberculosis, for the purpose of directing preventive measures for 05 the person, if the state medical officer has reasonable grounds to believe that the 06 person is at heightened risk of exposure to tuberculosis. 07 * Sec. 5. AS 18.15.135 is amended to read: 08  Sec. 18.15.135. TUBERCULOSIS EXAMINATIONS; EXAMINATION 09 ORDERS. (a) A person shall submit to an examination to detect tuberculosis [AN 10 ACTIVE CASE OF PULMONARY TUBERCULOSIS] whenever, in the opinion of 11 a state medical officer [OF THE DIVISION OF PUBLIC HEALTH], an examination 12 is necessary to preserve and protect public health. 13  (b) An examination under this section shall be by written order issued by a 14 state medical officer that must specify the name of the person to be examined and 15 the time and place of the examination. The person to be examined shall be personally 16 served with a copy of the order within a reasonable period of time before the 17 examination is to take place. 18  (c) An examination under this section shall be performed by a physician who 19 may lawfully practice [LICENSED] in the state. The person to be examined may, 20 under conditions specified by the state medical officer, choose the physician who will 21 perform the examination. 22 * Sec. 6. AS 18.15.136 is repealed and reenacted to read: 23  Sec. 18.15.136. ADDITIONAL ORDERS TO PROTECT THE PUBLIC 24 HEALTH. (a) In addition to orders issued under AS 18.15.135, if a state medical 25 officer determines that the public health in general, or the health of a particular person, 26 is endangered by exposure to a person who is known to have tuberculosis, or by 27 exposure to a person for whom there are reasonable grounds to believe has 28 tuberculosis, a state medical officer may issue the orders that the medical officer finds 29 necessary to protect the public from a threat to the public health. An examination 30 ordered under this section shall be performed by a physician who may lawfully 31 practice in the state. Under conditions specified by the state medical officer who 01 issued the order, the person to be examined may choose the physician who will 02 perform the examination. A state medical officer may not under this section order the 03 forcible or involuntary administration of medicine. The state medical officer, through 04 the Department of Law, may make application to a court for enforcement of an order 05 issued under this section. 06  (b) An order issued under (a) of this section may include 07  (1) an authorization for the removal to or admission into, a health care 08 facility for appropriate examination for infectious tuberculosis of a person who is 09 known to have tuberculosis, or of a person for whom there are reasonable grounds to 10 believe that the person has tuberculosis and who is unable or unwilling to submit to 11 an examination ordered under AS 18.15.135; 12  (2) a requirement that a person who has tuberculosis complete an 13 appropriate treatment plan for tuberculosis and, if necessary, follow required infection 14 control precautions for tuberculosis; 15  (3) a requirement that a person be removed to, admitted into, and 16 subsequently detained in, a health facility, if 17  (A) the person has infectious tuberculosis, or presents a 18 substantial likelihood of having infectious tuberculosis, based upon 19 epidemiologic information, clinical findings, X-ray readings, or tuberculosis 20 laboratory test results; and 21  (B) the state medical officer finds that a substantial likelihood 22 exists that the person may transmit tuberculosis to others because of the 23 person's inadequate separation from others; 24  (4) a requirement that a person be removed to, admitted into, and 25 subsequently detained in, a health care facility for treatment if 26  (A) the person has infectious tuberculosis, or has been reported 27 to a state medical officer as having infectious tuberculosis, and the state 28 medical officer has no knowledge that the person has completed an appropriate 29 treatment plan for tuberculosis; and 30  (B) substantial likelihood exists, based on the person's past or 31 present behavior, that the person cannot be relied upon to participate in or 01 complete an appropriate treatment plan for tuberculosis or, if necessary, follow 02 required infection control precautions for tuberculosis; the state medical officer 03 may consider as indicators of unreliability the person's refusal or failure to take 04 medication for tuberculosis, refusal or failure to keep appointments for 05 treatment for tuberculosis, refusal or failure to complete a treatment plan for 06 tuberculosis, or disregard for infection control precautions prescribed by a 07 health care provider or a state medical officer; 08  (5) an authorization for isolation of a person with infectious 09 tuberculosis through detention at the person's place of residence until the state medical 10 officer has determined that the person no longer has infectious tuberculosis. 11  (c) A state medical officer shall issue an order under this section in writing, 12 and in the order shall set out the following: 13  (1) the name of the person required to comply with the order, the 14 period of time during which the order is in effect, and other terms and conditions as 15 the state medical officer determines to be necessary to protect the public health; 16  (2) the legal authority under which the order is issued; 17  (3) an assessment of the person's circumstances or behavior constituting 18 the basis for the issuance of the order; and 19  (4) any less restrictive treatment alternatives that were attempted and 20 were unsuccessful, or less restrictive treatment alternatives that were considered and 21 rejected, and the reasons for the rejection of those alternatives. 22  (d) In addition to the requirements of (c) of this section, an order for the 23 detention of a person must include 24  (1) the purpose of the detention; 25  (2) advice to the person being detained that the person has the right to 26 request release from detention by contacting the state medical officer at the telephone 27 number stated on the order and that, under AS 18.15.139, in the absence of a court 28 order authorizing the detention, the detention may not continue for more than five 29 business days after the request for release; 30  (3) advice to the person being detained that, under AS 18.15.139, the 31 state medical officer is required to obtain, within 60 days following the commencement 01 of detention, a court order authorizing the detention and after that must seek further 02 court review of the detention within 90 days after the court order and within 90 days 03 after each subsequent court review; and 04  (4) advice to the person being detained that the person has the right to 05 arrange to be represented by counsel or, under AS 18.85.100, to have court-appointed 06 counsel provided. 07  (e) A state medical officer is not required to obtain a court order before issuing 08 an order under this section for detention of a person. 09 * Sec. 7. AS 18.15.137 is repealed and reenacted to read: 10  Sec. 18.15.137. EMERGENCY DETENTION ORDERS. A state medical 11 officer, through the Department of Law, may request the court to issue an order for the 12 emergency detention of a person when the state medical officer finds that a substantial 13 likelihood exists that the person has infectious tuberculosis in order to prevent the 14 person from posing a threat to the public health. Upon issuance of an ex parte court 15 order, a peace officer or a state medical officer shall take the person into custody and 16 deliver the person to the nearest available health care facility or another location that 17 will provide for the protection of the public health. The state medical officer, through 18 the Department of Law, shall make application for a court order authorizing continued 19 detention of the person within 72 hours after the issuance of an ex parte order or, if 20 the 72-hour period ends on a Saturday, Sunday, or legal holiday, by the end of the first 21 state working day following the Saturday, Sunday, or legal holiday. The court shall 22 schedule a hearing within five state working days after receipt of an application for 23 authorization of continued detention. 24 * Sec. 8. AS 18.15 is amended by adding a new section to read: 25  Sec. 18.15.139. COURT AUTHORIZATION OF DETENTION. (a) If a 26 person detained under an order issued under AS 18.15.136 requests release from 27 detention, the state medical officer shall make an application for a court order 28 authorizing continued detention within 72 hours after the request or, if the 72-hour 29 period ends on a Saturday, Sunday, or legal holiday, by the end of the first state 30 working day following the Saturday, Sunday, or legal holiday. The court shall 31 schedule a hearing within five state working days after receipt of the state medical 01 officer's application. After a detained person requests release, detention of that person 02 may not continue for more than five business days in the absence of a court order 03 authorizing continued detention. However, no person may be detained under an order 04 issued under AS 18.15.136 for more than 60 days without a court order authorizing the 05 detention. A state medical officer, through the Department of Law, shall seek further 06 court review of a detention within 90 days following the initial court order authorizing 07 the detention and within 90 days after each subsequent court order authorizing 08 detention. 09  (b) In a court proceeding to authorize or enforce a state medical officer's order 10 under AS 18.15.136 for the detention of a person, the state medical officer must prove 11 the circumstances constituting the necessity for the detention by clear and convincing 12 evidence. 13  (c) A person who is subject to a detention order under AS 18.15.136 has the 14 right to be represented by counsel or to have, under AS 18.85.100, court-appointed 15 counsel provided. 16 * Sec. 9. AS 18.15 is amended by adding a new section to read: 17  Sec. 18.15.143. RELIGIOUS TREATMENT FOR TUBERCULOSIS. If a 18 person with infectious tuberculosis establishes that that person is being provided 19 treatment for tuberculosis by spiritual means or establishes that the person's sincerely 20 held religious beliefs prohibit medical treatment, a state medical officer or the court, 21 in issuing an order under AS 18.15.136, 18.15.137, or 18.15.139, may consider the 22 spiritual treatment or religious beliefs as well as the health of the person and may 23 order that the person only be isolated at the person's home, or other suitable place of 24 the person's choice, in a manner that will protect the public health. 25  (b) A person with infectious tuberculosis who is or might become subject to 26 an order issued under AS 18.15.136, 18.15.137, or 18.15.139, at any time may request 27 recognition and consideration of spiritual treatment or religious beliefs as described in 28 (a) of this section. 29  (c) In this section, "spiritual means" means prayer, or a substantially similar 30 activity, by an established practitioner of a recognized church or religious 31 denomination, in accordance with the tenets and practices of that church or religious 01 denomination. 02 * Sec. 10. AS 18.15.145(a) is amended to read: 03  (a) An employee of a public or private elementary or secondary school in the 04 state shall be tested annually to detect infectious [ACTIVE CASES OF 05 PULMONARY] tuberculosis. An employee who has never had a positive test result 06 from a tuberculin skin test shall obtain a tuberculin skin test. An employee whose skin 07 test result is positive or who has ever had a positive skin test result shall have an 08 appropriate health screening examination that may include obtaining [OBTAIN] 09 a chest X-ray. 10 * Sec. 11. AS 18.15 is amended by adding new sections to read: 11  Sec. 18.15.147. LIMITED IMMUNITY. A person may not bring an action for 12 damages based on the decision under AS 18.15.120 - 18.15.149 to detain or not to 13 detain a person, unless the action is for damages caused by gross negligence or 14 intentional misconduct. 15  Sec. 18.15.148. PENALTY. A person who violates the terms of an order 16 issued under AS 18.15.135 - 18.15.136 is guilty of a class A misdemeanor. 17  Sec. 18.15.149. DEFINITIONS. In AS 18.15.120 - 18.15.149, 18  (1) "department" means the Department of Health and Social Services; 19  (2) "division of public health" means the division of public health in 20 the department; 21  (3) "health care provider" means an acupuncturist, nurse, nurse 22 practitioner, pharmacist, physician, or physician's assistant, hospital, or health clinic 23 who may lawfully practice in this state; 24  (4) "health care facility" means a hospital, specialty hospital, long-term 25 care facility, medical clinic, or similar facility for which a license has been issued by 26 this state and in which inpatient or outpatient medical services for tuberculosis are 27 provided; 28  (5) "state medical officer" means a physician employed by the division 29 of public health; 30  (6) "tuberculosis" means a disease caused by mycobacterium 31 tuberculosis, mycobacterium bovis, or mycobacterium africanum. 01 * Sec. 12. AS 18.85.100(a) is amended to read: 02  (a) An indigent person who is being detained by a law enforcement officer in 03 connection with a serious crime, or is under formal charge of having committed, or is 04 being detained under a conviction of a serious crime, or is on probation or parole, or 05 is entitled to representation under the Supreme Court Delinquency or Child in Need 06 of Aid Rules, or is detained under an order issued under AS 18.15.120 - 18.15.149 07 or against whom commitment proceedings for mental illness have been initiated, is 08 entitled 09  (1) to be represented by an attorney to the same extent as a person 10 retaining an attorney is entitled; and 11  (2) to be provided with the necessary services and facilities of this 12 representation, including investigation and other preparation. 13 * Sec. 13. AS 18.15.138 is repealed. 14 * Sec. 14. The Department of Health and Social Services may immediately proceed to 15 adopt regulations to implement the changes made by this Act. The regulations take effect 16 under AS 44.62 (Administrative Procedure Act), but not before July 1, 1995. 17 * Sec. 15. Section 14 of this Act takes effect immediately under AS 01.10.070(c). 18 * Sec. 16. Except as provided in sec. 15 of this Act, this Act takes effect July 1, 1995.